MEDICARE: DR. BASHAR PHAROAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D0019637	MD

General Provider Information

NPI Number	:	1285738633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASHAR PHAROAN MD

Provider Business Mailing Address
First Line	:	PO BOX 452
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21094-0452
Country	:	US
Telephone Number	:	410-241-1670
Fax Number	:	410-252-4929

Provider Business Practice Location Address
First Line	:	4744 RIDGE ROAD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21236
Country	:	US
Telephone Number	:	410-241-1670
Fax Number	:	410-252-4929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/09/2007

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